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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 <br /> HOUR <br /> CODE~A-PHONE: <br /> <br />, am perforrJ,ling work o. a Droperty ] own or oootlDy .- ~~~ <br />I am a registered builder OR he au hot zed epresen ave X~ GNATURE OF APPLrCAN <br />of & registered builder, f' ~' ' - ....... <br />The work will be performed by a registered builder. · ' , · · <br /> <br />'[nh,~v;or~u~m~¢n~d agree tofhe terms steted on the reverses 'e of ~,~DAT ! / ~4~,.~ <br /> <br /> ........... ""~(" '"~- rA× LOT: ...... CATEGORY: <br />,¢ ~], 2"'6'L ,~]!97'" 557 <br /> <br />~-MAI~,IN'6ADDRESS' ....................................................................................................................... ~USD V S ON: ................ <br /> <br />'L~T~ ................... I~LOCF(; .............SECTION; ............... <br /> <br /> ~'~4: ............ <br /> .. 'l, <br /> <br />WR'TER SUFd;'LY: <br />TE!:Vf' HOI..i;;S RE~DY: <br />S];'FE ,EVALUATt[}N <br /> <br />EX]:S-FTN6 DRRIN F]'EL.~ LINES: <br />SEP'I"IC .'TANK <br /> <br />¢~!/D.[TION¢,L SUBSUEFNCE FEE'~ , <br />¢,l):O[¢I.Jlh,:l .... IF h~ ,~. - S,~.URF <br /> <br />[~ LI A N T 't' T V A Y!~ L.I ~ i T <br /> <br />T -1~$ '?F;'r'~' P r <br /> <br />$85. <br /> <br />; ., .,..l ..,,:-. l E~'r ,H I~liiF'¢;]]~'~ (ba:L (:[Lie) t~x <br /> <br /> <br />